Indications for surgical antibiotic prophylaxis in dentistry

Surgical antibiotic prophylaxis is rarely indicated for dental procedures—see Dental procedures and their requirement for surgical antibiotic prophylaxis. The recommendations to use surgical antibiotic prophylaxis are informed, when possible, by evidence that prophylaxis is beneficial for the relevant procedure and patient group. Furthermore, the potential benefits of preventing postoperative infection with surgical antibiotic prophylaxis is balanced against the potential harms of antimicrobial use (eg diarrhoea, rash, bacterial resistance; see also Types of adverse effects of antimicrobials).

Note: Surgical antibiotic prophylaxis is rarely indicated for dental procedures.

The role of surgical antibiotic prophylaxis for patients with profound immune compromise who are undergoing an invasive dental procedure is uncertain. Discuss the need for surgical antibiotic prophylaxis with the treating specialist or multidisciplinary team.

Even if surgical antibiotic prophylaxis is not indicated, consider the need for treatment of acute odontogenic infection or infective endocarditis prophylaxis.

For the role of surgical antibiotic prophylaxis before dental procedures in patients with a prosthetic joint, see here.

For the role of surgical antibiotic prophylaxis before dental procedures in patients with a breast implant, see here.

Do not use prophylactic antibiotics to prevent alveolar osteitis (dry socket), which is a post-extraction complication caused by premature clot lysis rather than infection.

Note: Prophylactic antibiotics do not prevent alveolar osteitis.
Table 1. Dental procedures and their requirement for surgical antibiotic prophylaxis

Procedures

Is surgical antibiotic prophylaxis indicated?

tooth extractions

third molar surgery

procedures involving insertion of dental implants

periodontal surgery

periapical surgery

soft and hard tissue removal

NO [NB1]

oral maxillofacial procedures

see Surgical prophylaxis for oral maxillofacial surgery

dental procedures not listed above

NO

Note: NB1: For patients with profound immune compromise, discuss the need for surgical antibiotic prophylaxis with the multidisciplinary team or treating specialists.

If prophylaxis is indicated, follow the principles for appropriate prescribing of surgical antibiotic prophylaxis in Dental procedures and their requirement for surgical antibiotic prophylaxis.

Figure 1. Principles for appropriate prescribing of surgical antibiotic prophylaxis in dentistry
  • Do not use surgical antibiotic prophylaxis unless there is a clear indication for its use—see Dental procedures and their requirement for surgical antibiotic prophylaxis.
  • The choice of antibiotic is determined by the susceptibilities of the organism(s) most likely to cause postoperative infection. Antibiotic choice may need to be modified in certain circumstances—see here.
  • If prophylaxis is indicated, a single preoperative dose of antibiotic(s) is usually sufficient—postoperative doses are not required.
  • Surgical antibiotic prophylaxis must be administered before surgical incision. For short-acting antibiotics, such as amoxicillin, the dose should be administered no more than 60 minutes before incision.